Is Endometriosis Associated with Systemic Subclinical Inflammation?

Agic, Admir; Xu, Hong; Finas, D.; Banz, C.; Diedrich, K.; Hornung, Daniela

doi:10.1159/000093121

Cited by 203 publications

(154 citation statements)

References 125 publications

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“…1 There is general agreement that endometriosis is a pelvic inflammatory process; however, research has suggested that endometriosis is also characterized by systemic inflammation. 4,5 Various kinds of inflammatory factors have been found to be elevated in peritoneal fluid and in the peripheral blood among women with endometriosis compared with controls. [5][6][7][8] Several case-control studies have found that women with endometriosis had higher serum levels of low-density lipoprotein (LDL) or oxidized LDL compared with controls.…”

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confidence: 99%

“…4,5 Various kinds of inflammatory factors have been found to be elevated in peritoneal fluid and in the peripheral blood among women with endometriosis compared with controls. [5][6][7][8] Several case-control studies have found that women with endometriosis had higher serum levels of low-density lipoprotein (LDL) or oxidized LDL compared with controls. [9][10][11] It is possible that chronic inflammation, such as that associated with endometriosis, could impact lipid metabolism through various mechanisms and lead to high LDL levels 12,13 -the primary form of hypercholesterolemia.…”

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Association Between Endometriosis and Hypercholesterolemia or Hypertension

et al. 2017

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Abstract-An altered hormonal or chronic systemic inflammatory milieu characterizing endometriosis may result in a higher risk of hypercholesterolemia and hypertension. Conversely, elevated low-density lipoprotein in hypercholesterolemia and chronic systemic inflammation resulting from hypertension may increase the risk of endometriosis. We assessed the association of laparoscopically confirmed endometriosis with hypercholesterolemia and hypertension in a large prospective cohort study. In 1989, 116 430 registered female nurses aged 25 to 42 completed the baseline questionnaire and were followed for 20 years. Multivariable Cox proportional hazards models were applied. In 1989, there were 4244 women with laparoscopically confirmed endometriosis and 91 554 women without. After adjusting for demographic, anthropometric, family history, reproductive, dietary, and lifestyle risk factors prospectively, comparing women with laparoscopically confirmed endometriosis to women without, the relative risks were 1.25 (95% confidence interval, 1.21-1.30) for development of hypercholesterolemia and 1.14 (95% confidence interval, 1.09-1.18) for hypertension. Conversely, the relative risks of developing laparoscopically confirmed endometriosis were 1.22 (95% confidence interval, 1.15-1.31) comparing women with hypercholesterolemia to women without and 1.29 (95% confidence interval, 1.18-1.41) comparing women with hypertension to women without. The strength of associations of laparoscopically confirmed endometriosis with hypercholesterolemia or hypertension was strongest among women aged ≤40 and weakened as age increased (P values for interaction <0.001). We observed that ≈45% of the associations between endometriosis and hypercholesterolemia and hypertension could be accounted for by treatment factors after endometriosis diagnosis, including greater frequency of hysterectomy/oophorectomy and earlier age for this surgery. In this large cohort study, laparoscopically confirmed endometriosis was prospectively associated with increased risk of hypercholesterolemia and hypertension. Conversely, hypercholesterolemia and hypertension were prospectively associated with higher risk of laparoscopically confirmed endometriosis. process, which may be contributing to blood pressure elevation. 23 Hence the chronic systemic inflammation in endometriosis may predispose women with endometriosis to a higher risk of hypertension.In sum, women with endometriosis may have higher risk of hypercholesterolemia or hypertension, and women with hypertension or hypercholesterolemia may have a higher risk of endometriosis. We examined these hypotheses in the NHSII (Nurses' Health Study II), an ongoing prospective cohort study. Methods Study PopulationThe NHSII is a prospective cohort study with 116 430 registered female nurses who were 25 to 42 and resided in 14 of the United States at enrollment in 1989. At baseline, participants completed a detailed questionnaire and every 2 years thereafter completed follow-up questionnaires on the incidence of disease out...

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Association Between Endometriosis and Hypercholesterolemia or Hypertension

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“…17,18 The resulting fibrosis and stricture formation may be the reason behind most intestinal endometriosis lacking the classical cyclical abdominal pain during menstrual cycle.…”

Section: 13mentioning

confidence: 99%

Small bowel obstruction due to subserosal endometriosis: an elusive condition

Mishra

Vats

Pandey

et al. 2016

Int J Reprod Contracept Obstet Gynecol

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“…Endometriosis is often accompanied by marked changes in the number and function of inflammatory products, including human neutrophil peptides belonging to the α-defensin family (11), macrophage migration inhibitory factor (MIF) (12), C-C chemokine monocyte chemoattractant protein-1 (MCP-1), serum amyloid A (SAA), TNF-α, IL-1, IL-6, IL-8, chemokine (C-C motif) receptor 1 (CCR1) (13) and regulated on activation, normal T cell expressed and secreted (RANTES) (14). Defensin is involved in innate immunity against bacteria and kills microbes.…”

Section: Innate Immunity and Inflammation In Endometriosismentioning

confidence: 99%

Pathogenesis of endometriosis: The role of initial infection and subsequent sterile inflammation (Review)

Kobayashi

Higashiura

Shinmoto

et al. 2013

Molecular Medicine Reports

109

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Abstract. Endometriosis is a common type of chronic inflammatory disease with an immunological background. In this review, we aimed to explore the contemporary literature on the infection and sterile inflammation that support the pathogenesis of endometriosis. This article reviews the English-language literature on inflammatory, environmental, immunological and oxidative factors associated with endometriosis in an effort to identify factors that cause a predisposition to endometriosis. Intrauterine microbes may be critical for the initiation of endometriosis; the initial activation of pathogen recognition receptors by microbial stimuli results in the activation of proinflammatory pathways and innate immunity. In addition to their response to various exogenous pathogen-associated molecular patterns, Toll-like receptors (TLRs) also recognize a wide range of endogenous danger-associated molecular patterns (DAMPs). The increased expression levels of DAMPs may be involved in the subsequent process of nuclear transcription factor-κB-dependent sterile inflammation. Oxidative stress, secondary to the influx of iron during retrograde menstruation, is involved in the progression of endometriosis. DAMP-mediated danger signals and oxidative stress are bidirectional during sterile inflammation (danger signal spiral). This review supports the hypothesis that there are at least two distinct phases of endometriosis development: The initial wave of TLR activation in modulating innate immune responses would be followed by the second big wave of sterile inflammation.

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Is Endometriosis Associated with Systemic Subclinical Inflammation?

Cited by 203 publications

References 125 publications

Association Between Endometriosis and Hypercholesterolemia or Hypertension

Association Between Endometriosis and Hypercholesterolemia or Hypertension

Small bowel obstruction due to subserosal endometriosis: an elusive condition

Pathogenesis of endometriosis: The role of initial infection and subsequent sterile inflammation (Review)

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